Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis

Abstract

Purpose: C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment. Methods: Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD). Results: Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2–3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2–3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; p < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile. Conclusion: CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

“…Detailed diagnostic work-up, including a mandatory maxillofacial assessment, is strongly recommended [54]. CRP has been shown to be a predictable serum parameter in patients with spondylodiscitis, while the WBC count is unspecific [55]. One recent study proposed that, if CRP does not fall after the third postoperative day, antibiotic treatment should be reassessed, and concomitant infections screened [55].…”

“…CRP has been shown to be a predictable serum parameter in patients with spondylodiscitis, while the WBC count is unspecific [55]. One recent study proposed that, if CRP does not fall after the third postoperative day, antibiotic treatment should be reassessed, and concomitant infections screened [55]. Implementation of a weekly infection conference consisting of a surgeon, medical microbiologist, infectious disease specialist and pathologist has shown the improvement of treatment of spondylodiscitis with reduced days of total antibiotic treatment and more frequent open transpedicular screw placement with less involved spinal segments [56].…”

Improving rehabilitation and quality of life after percutaneous transhepatic cholangiography drainage with a rapid rehabilitation model

“…A WBC count is a primary component of a routine blood examination and also an important indicator of acute infectious diseases. When acute severe inflammation, acute suppurative inflammation, bacterial infection, and severe tissue damage occur, WBC changes are significant[ 17 , 18 ]. In this study, the WBC count and CRP levels significantly decreased in both groups after PTCD compared with before PTCD, and were lower in the observation group than in the control group after PTCD.…”

Monomeric CRP regulates inflammatory responses in human intervertebral disc cells

“…Some of the published IVD disease literature assesses CRP as a reference biomarker of an ongoing inflammatory process. 15 , 26 , 27 Ruiz-Fernández et al 24 recently investigated the inflammatory effect of mCRP in chondrocytes, proving that mCRP triggers a sustained proinflammatory and catabolic state in healthy and OA cartilage. However, the role of mCRP in disc pathophysiology has not yet been clarified.…”